Risk Factors for Complications after Skin-Sparing and Nipple-Sparing Mastectomy

Abstract

Introduction: In order to achieve a complication-free breast reconstruction, it is fundamental for each individual patient case to determine preoperatively certain risk factors that might have a negative impact on the postoperative result after skin-sparing (SSM) or nipple-sparing mastectomy (NSM). Methods: A retrospective study of 39 female breast cancer patients who received SSM or NSM breast reconstruction in our department (time interval: 2010–2015), was performed. The study focus is on determining patient characteristics (e.g., demographics, history of radiotherapy/chemotherapy, menopausal status, amount of resected breast tissue) leading to higher complication rates. Results: Overall, 50 mastectomies (27 SSM and 23 NSM) with 6 immediate and 35 immediate 2-stage tissue expander breast reconstructions amounting to a total of 41 surgical interventions (n = 41) were carried out. Median follow-up time was 2 years and 5 months (range 121–1,863 days). Increased complication rates were associated with the following patient characteristics: age >50 years (p < 0.05) and personal history of cardiovascular disease (p < 0.05). Increased but not significant risk factors included postmenopausal status (p = 0.07), radiotherapy prior to SSM/NSM (p = 0.06), and weight of resected breast tissue >438 g (p = 0.09). Conclusion: This work identified age >50 years and personal history of cardiovascular disease to be risk factors for increased complication rates following SSM and NSM. Therefore, the given findings should be taken into account when selecting patients for these 2 procedures.

Investigation of the current situation of nipple-sparing mastectomy: a large multicenter study in China (CSBrs-003)

“…Surgical incision options and surgical types should be evaluated based on the tumor situation and patient needs. [ 18 ] This study showed that different surgical types ( P = 0.154) and surgical incisions ( P = 0.098) did not relate to the postoperative complication rate. Restricted by strict indications, NSM is recommended more to patients with a poor expected outcome of breast-conserving surgery (smaller breasts, negative surgical margins cannot be achieved by breast-conserving surgery).…”

“…Most studies have shown that the incidence of NAC involvement was significantly associated with tumor size. [ 7 , 18 ] Some studies suggested that NSM can be performed safely regardless of tumor size, as long as the deep nipple and areola area had negative surgical margins. [ 19 ] With a threshold tumor diameter of 2 cm, tumor size did not significantly relate to the rates of postoperative complications, recurrence, and metastasis after NSM.…”

Predicting Nipple Necrosis with a “Lights-on” Indocyanine Green Imaging System: A Report of Two Patients

“…Patient characteristics such as smoking history, prior radiation, increasing BMI, and large ptotic breasts have demonstrated an increased risk. 11 12 Given that radiotherapy is recommended in more advanced cancers or those with high-grade features, that may also result in a greater risk of nipple necrosis. However, this was not the case for either of our patients who were diagnosed with low-grade in situ cancers.…”

Laparoscopically Harvested Omental Flap for Immediate Total Breast Reconstruction; Lessons Learnt Through Ten-Year Experience in a Tertiary Oncology Center

“…The operation is not morbid as the rate of mastectomy complications is nearly as reported by other studies describing pure mastectomy. 17,18 The incidence of epigastric hernia is low, and this complication can be avoided by proper tunnel closure. The incidence of partial breast envelop ischemia was 5.4%, and this was exclusively met with the inframammary incision due to the longer flap.…”